临床体格检查诊断直肠套叠的精确度

作     者：Karlbom U. Graf W. Nilsson S. Phlman L. 赵天智 

作者机构：Department of Surgery University Hospital SE-751 85 Uppsala SwedenDr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2005年第1卷第2期

页      面：19-20页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：直肠套叠 临床体格检查 排便造影 功能性便秘 便秘患者 肛门直肠 直肠镜检查 症状持续时间 临床判断 临床相关性 

摘      要：PURPOSE: This study was designed to compare routine clinical examination and d efecography in the diagnosis of rectal intussusception in constipated patients a nd study relationships between rectal intussusception and symptoms. METHODS: A t otal of 127 consecutive patients with functional constipation were examined in t he left-lateral position with rectal palpation and rectoscopy according to a pr otocol. An overall clinical judgment was made if the patient had intussusception , unclear finding, or no intussusception. Defecography was performed without kno wledge of the results of the clinical evaluation. Symptomduration varied between 0.5 to 60 (median, 10) years. All patients fulfilled a bowel questionnaire and all had a full physiologic workup. RESULTS: A diagnosis by digital examination ( P = 0.002) and by rectoscopy (P = 0.002) as well as the overall judgment (P = 0. 0002) was clearly related to a longer intussusception as measured by defecograph y. Five of six intraanal intussusceptions were correctly assessed by clinical examinat ion,whereas the correlation to defecographywas poor in the group with short intu ssusceptions. Neither clinical nor defecographic diagnosis of rectal intussuscep tion were related to the main symptoms of constipation but both were associated with a tendency toward lower anal resting pressures (P = 0.04 and P = 0.06) and an obtuse anorectal angle (during evacuation, P = 0.01 and P = 0.01). CONCLUSION S: There is no clear relationship between rectal intussusception and constipatio n. However, intussusception is related to sphincter function and may be of clini cal relevance. A normal clinical examination will exclude most long intussuscept ions, whereas a positive finding needs further evaluation with defecography.